This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) from NHLBI to enable Mr. John Todaro to develop research expertise in studying gender differences in patients participating in cardiac rehabilitation (CR). John Todaro will work closely with his mentor, Dr. Niaura, and his co-mentors Drs. Marcus, Friedman, and Tilkemeier at the Brown University School of Medicine, as well as with co-mentor Dr. Blumenthal from Duke University. John Todaro's short-term goals are to enhance the theoretical, methodological, and statistical skills that he needs to study gender differences related to CHD and its associated treatments. His long-term goals are to develop an independent laboratory, as well as a network of research collaborators devoted to advancing our understanding of the behavioral aspects of managing CHD and training future clinical researchers. Although CR continues to be a vital component of CHD management for both men and women, much of the research examining CR outcomes has focused its attention on men. The proposed study will examine if men and women experience similar psychological, quality of life, and medical benefits from participation in cardiac rehabilitation. Aim 1 of the proposed study is to compare the long-term psychological and quality of life benefits of CR in men and women. The hypothesis is that, since women are often older, manage multiple comorbid medical conditions, and have fewer sources of social support, women will experience fewer benefits than their male counterparts in terms of improvements in psychological functioning (depression and anxiety) and quality of life. Aim 2 of the proposed study is to compare rates of cardiac morbidity and mortality in men and women participating in CR. The hypothesis is that, since women present with these less favorable premorbid characteristics and, given that women experience fewer psychological benefits from CR, women will experience more episodes of incident heart disease (i.e., angina pectoris, myocardial infarction) and demonstrate higher rates of mortality over a two-year period than men. Aim 3 of the proposed study is to explore the impact of CR on subsequent medical utilization variables including number of clinic visits, number and types of revascularization procedures performed, and number and length of hospitalizations in men and women. Results of the proposed study should increase our understanding of the differential long-term benefits of CR for men and women. These data will assist John Todaro to establish an empirical foundation from which to develop novel interventions to address the specific challenges experienced by women as well as men participating in CR.